eMedicine Specialties > Dermatology > Environmental

Prurigo Nodularis: Follow-up

Author: Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Coauthor(s): Siobahn M Bower, MD, Internal Medicine Resident, Creighton University; Sharron M Mason, MD, Staff Physician, Department of Internal Medicine, University of Kansas School of Medicine; Stephen H Mason, MD, Assistant Professor of Dermatology, Medical College of Georgia
Contributor Information and Disclosures

Updated: Oct 23, 2009

Follow-up

Further Outpatient Care

  • Monitor patients with prurigo nodularis for the following:
    • Signs of improvement
    • Resistance to treatment
    • Development of symptoms or signs of underlying medical or psychiatric conditions
    • Atypical lesions meriting skin biopsy
    • Use of alternative therapies that may actually worsen atopic dermatoses

Complications

  • Some healed lesions show pigmentary changes and scarring.

Prognosis

  • The prognosis for spontaneous remission of prurigo nodularis is not good. Once prurigo nodularis lesions occur, complete resolution of lesions is rare. Most lesions remain present in some form even after long-term treatment. At this time, treating more than just the most symptomatic lesions is difficult. Considerable time is usually required to slow or stop the itch/scratch cycle so that the lesions resolve.
  • Ultimately, a strong therapeutic alliance is the best outcome predictor because the course of the disease is long, with waxing and waning symptoms, making the patient prone to being subjected to excessive diagnostic procedures and to seek alternative therapies.

Miscellaneous

Medicolegal Pitfalls

  • In the diagnosis of prurigo nodularis, proving that the observed lesions are prurigo nodularis rather than skin cancers is important, especially in patients who express this concern. Performing a biopsy is important, especially when the lesion is solitary.
  • When treating prurigo nodularis with intralesional steroids or topical steroids under occlusion, overaggressively treating the condition is not necessary because this may potentially cause local cutaneous atrophy.
 


More on Prurigo Nodularis

Overview: Prurigo Nodularis
Differential Diagnoses & Workup: Prurigo Nodularis
Treatment & Medication: Prurigo Nodularis
Follow-up: Prurigo Nodularis
Multimedia: Prurigo Nodularis
References
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Further Reading

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Keywords

prurigo nodularis, Hyde prurigo nodularis, picker’s nodules, lichen simplex chronicus, prurigo nodularis type, atypical nodular form of neurodermatitis circumscripta, lichen corneus obtusus, PN

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Contributor Information and Disclosures

Author

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Coauthor(s)

Siobahn M Bower, MD, Internal Medicine Resident, Creighton University
Siobahn M Bower, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Sharron M Mason, MD, Staff Physician, Department of Internal Medicine, University of Kansas School of Medicine
Disclosure: Nothing to disclose.

Stephen H Mason, MD, Assistant Professor of Dermatology, Medical College of Georgia
Stephen H Mason, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, Skin Cancer Foundation, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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